space and place in an e-health world

I’ve often stated that we need to explore and understand some of the consequences of adopting and using more ehealth. By consequences, I don’t necessarily mean negative effects. In his book, Amusing Ourselves to Death: Public Discourse in the Age of Show Business, Neil Postman articulates some of the (unintended) consequences of using the television. For example, he explores how use of multimedia de-emphasizes print and how television encourages the development of shorter attention spans.

Now, as for ehealth, I wonder if there are similar ramifications. The concepts of space and come to mind. In the past, I have been a strong advocate for using ehealth technologies to allow people to communicate, collaborate, and connect irrespective of place – the technology allows us to do this. However, I wonder if my position was naive. “Place” and “space” do play important and powerful roles in our lives – just think about the concept of “home”. We all have powerful associations to the place that we call “home”. Do we have a similar attachment to the places that we set aside for work and even for care?

Some of the rationale for moving care back into the home has been borne from the notion that people want to receive care in the home – costing less helps too, right? Well, what does that mean for our public institutions? Imagine if everyone was connected via the Internet and that almost all of the health care interactions took place “virtually”. What would happen to the places that we call “hospitals”? Would these public gathering places cease to exist?

A colleague informs me that patients have strong connections to the places in which they receive care. One example is dialysis treatment. When given the opportunity to receive dialysis treatment at home at night, some patients get concerned because they would miss out on the social bonding that occurs at the hospital. These patients have spent countless hours in one place receiving treatment, and additionally (but perhaps more importantly) relationships with other patients. Will virtual spaces be able to re-create the physical places that we currently occupy?

Richard Florida, author of Rise of the Creative Class, argues that place is very important. He even goes so far as to suggest that place is perhaps the most important factor in determining a city’s (and even a nation’s) future economic survival. I just wonder if by (arguably) saving money and making the system more responsive that we are in fact losing something valuable without realizing the consequence.

If you’re interested in exploring some of these issues, feel free to visit the Health Care, Technology, and Place program. One of the explicit areas of research is place. I will continue to write about place and space as I think about this topic more.